[abstract] Hawaiian Deep Treatments, Efficacy and Outcomes, 1983-2001

INTRODUCTION: This paper reports on outcomes and efficacy of the deep treatment schedules employed at the University of Hawaii to treat diving accident victims. These tables utilize increased atmospheric pressures (2.8ATA[282kPa] to 9.4ATA[961kPa]), several mixed gas combinations(Nitrox 65/35 and 50/50), and a more gradual staged decompression rate. METHODS: A retrospective study of 824 cases of dysbarism used quantitative and qualitative methods to assess effectiveness of these tables. Patients were diagnosed as either AGE or DCS. DCS cases were sub-categorized as cerebral, spinal, peripheral nerve, vestibular, or pain only. Patients were assigned an initial severity score of 0-4 based upon history/physical findings at time of presentation. Post treatment, patients were assigned a residual score of 0-4 based upon function/physical findings at time of discharge. To assess degree of improvement obtained from treatment, an improvement score of 0-4 was determined by subtracting residual scores from initial severity scores and percent recovery was calculated by dividing improvement score by initial severity score. Outcomes by condition and treatment table employed were determined. Average number of treatments required to obtain outcomes was determined. RESULTS: 75percent of our study population was treated using a single specific treatment schedule. Average percent recoveries per condition treated ranged from 88.7percent to 97.9percent, and from 89.5percent to 96.2percent based upon treatment table employed. Average number of treatments required ranged from 1.1 to 1.2 treatments. 25percent of study population was treated using multiple treatment schedules and tended to have more severe disease, poorer outcomes, and required more treatments. CONCLUSION: These outcomes appear to be better than those reported nationwide by DAN for that portion of our study population in which we were able to make comparison. Severity of injury and age of diver were the most sensitive predictors of outcome while delay to treatment did not influence outcomes in this study population.